A BILL to amend and reenact §5-16-9 of the Code of West Virginia,
1931, as amended, relating to requiring the Public Employees
Insurance Agency and its contractors, under certain
circumstances, to advertise that they are seeking bids prior
to accepting bids for contracts.

Be it enacted by the Legislature of West Virginia:

That §5-16-9 of the Code of West Virginia, 1931, as amended,
be amended and reenacted to read as follows:

ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.

§5-16-9. Authorization to execute contracts for group hospital and
surgical insurance, group major medical insurance,
group prescription drug insurance, group life and
accidental death insurance and other accidental death
insurance; mandated benefits; limitations; awarding of
contracts; reinsurance; certificates for covered
employees; discontinuance of contracts.

(a) The director is hereby given exclusive authorization to
execute such contract or contracts as are necessary to carry out
the provisions of this article and to provide the plan or plans of
group hospital and surgical insurance coverage, group major medical
insurance coverage, group prescription drug insurance coverage and
group life and accidental death insurance coverage selected in
accordance with the provisions of this article, suchthe contract
or contracts to be executed with one or more agencies,
corporations, insurance companies or service organizations licensed
to sell group hospital and surgical insurance, group major medical
insurance, group prescription drug insurance and group life and
accidental death insurance in this state.

(b) The group hospital or surgical insurance coverage and
group major medical insurance coverage herein provided in this
article shall include coverages and benefits for X ray and
laboratory services in connection with mammogram and pap smears
when performed for cancer screening or diagnostic services and
annual checkups for prostate cancer in men age fifty and over.
SuchThe benefits shall include, but are not be limited to, the
following:

(1) Mammograms when medically appropriate and consistent with
the current guidelines from the United States Preventive Services
Task Force;

(2) A pap smear, either conventional or liquid-based cytology,
whichever is medically appropriate and consistent with the current
guidelines from the United States Preventive Services Task Force or
The American College of Obstetricians and Gynecologists, for women
age eighteen and over;

(3) A test for the human papilloma virus (HPV) for women age
eighteen or over, when medically appropriate and consistent with
the current guidelines from either the United States Preventive
Services Task Force or The American College of Obstetricians and
Gynecologists for women age eighteen and over;

(4) A checkup for prostate cancer annually for men age fifty
or over; and

(5) Annual screening for kidney disease as determined to be
medically necessary by a physician using any combination of blood
pressure testing, urine albumin or urine protein testing and serum
creatinine testing as recommended by the National Kidney
Foundation.

(6) Coverage for general anesthesia for dental procedures and
associated outpatient hospital or ambulatory facility charges
provided by appropriately licensed healthcare individuals in
conjunction with dental care if the covered person is:

(A) Seven years of age or younger or is developmentally
disabled and is either an individual for whom a successful result
cannot be expected from dental care provided under local anesthesia
because of a physical, intellectual or other medically compromising
condition of the individual and for whom a superior result can be
expected from dental care provided under general anesthesia; or

(B) A child who is twelve years of age or younger with
documented phobias, or with documented mental illness, and with
dental needs of such magnitude that treatment should not be delayed
or deferred and for whom lack of treatment can be expected to
result in infection, loss of teeth or other increased oral or
dental morbidity and for whom a successful result cannot be
expected from dental care provided under local anesthesia because
of such condition and for whom a superior result can be expected
from dental care provided under general anesthesia.

(c) The group life and accidental death insurance herein
provided in this article shall be in the amount of $10,000 for
every employee. The amount of the group life and accidental death
insurance to which an employee would otherwise be entitled shall be
reduced to $5,000 upon suchthe employee attaining age sixty-five.

(d) All of the insurance coverage to be provided for under
this article may be included in one or more similar contracts
issued by the same or different carriers.

(e) (1) The provisions of article three, chapter five-a of
this code, relating to the Division of Purchasing of the Department
of Finance and Administration, shalldo not apply to any contracts
for any insurance coverage or professional services authorized to
be executed under the provisions of this article.

(2) Before entering into any contract for any insurance
coverage, as authorized in this article, the director shall:

(A) Invite competent bids from all qualified and licensed
insurance companies or carriers, who may wish to offer plans for
the insurance coverage desired; and

(B) Advertise that the director is seeking bids using
advertising media such as the purchasing bulletin, newspapers,
trade journals, or any other media targeted at those in West
Virginia who may want to submit a bid and give those interested at
least thirty days to submit a bid or notice of interest.

Provided, That(3) After the thirty-day period is complete,
the director shall negotiate and contract directly with health care
providers and other entities, organizations and vendors in order to
secure competitive premiums, prices and other financial advantages.

(4) The director shall deal directly with insurers or health
care providers and other entities, organizations and vendors in
presenting specifications and receiving quotations for bid
purposes.

(5) No commission or finder's fee, or any combination thereof,
shallmay be paid to any individual or agent; but this shalldoes
not preclude an underwriting insurance company or companies, at
their own expense, from appointing a licensed resident agent,
within this state, to service the companies' contracts awarded
under the provisions of this article. Commissions reasonably
related to actual service rendered for the agent or agents may be
paid by the underwriting company or companies: Provided, however,
That in no event shallmay payment be made to any agent or agents
when no actual services are rendered or performed.

(6) The director shall award the contract or contracts on a
competitive basis. In awarding the contract or contracts the
director shall take into account the experience of the offering
agency, corporation, insurance company or service organization in
the group hospital and surgical insurance field, group major
medical insurance field, group prescription drug field and group
life and accidental death insurance field, and its facilities for
the handling of claims. In evaluating these factors, the director
may employ the services of impartial, professional insurance
analysts or actuaries or both. Any contract executed by the
director with a selected carrier shall be a contract to govern all
eligible employees subject to the provisions of this article.

(7) Nothing contained in this article shall prohibitprohibits
any insurance carrier from soliciting employees covered hereunderunder this article to purchase additional hospital and surgical,
major medical or life and accidental death insurance coverage.

(f) The director may authorize the carrier with whom a primary
contract is executed to reinsure portions of the contract with
other carriers which elect to be a reinsurer and who are legally
qualified to enter into a reinsurance agreement under the laws of
this state.

(g) Each employee who is covered under any contract or
contracts shall receive a statement of benefits to which the
employee, his or her spouse and his or her dependents are entitled
under the contract, setting forth the information as to whom the
benefits are payable, to whom claims shall be submitted and a
summary of the provisions of the contract or contracts as they
affect the employee, his or her spouse and his or her dependents.

(h) The director may at the end of any contract period
discontinue any contract or contracts it has executed with any
carrier and replace the same with a contract or contracts with any
other carrier or carriers meeting the requirements of this article.

(i) The director shall provide by contract or contracts
entered into under the provisions of this article the cost for
coverage of children's immunization services from birth through age
sixteen years to provide immunization against the following
illnesses: Diphtheria, polio, mumps, measles, rubella, tetanus,
hepatitis-b, haemophilus influenzae-b and whooping cough.
Additional immunizations may be required by the Commissioner of the
Bureau for Public Health for public health purposes. Any contract
entered into to cover these services shall require that all costs
associated with immunization, including the cost of the vaccine, if
incurred by the health care provider, and all costs of vaccine
administration be exempt from any deductible, per visit charge
and/or copayment provisions which may be in force in these policies
or contracts. This section does not require that other health care
services provided at the time of immunization be exempt from any
deductible and/or copayment provisions.

(j) Any contract that the director enters under this article
which contains provisions authorizing the person to whom the
contract is awarded to subcontract portions of the contract shall
require the contractor to advertise, prior to awarding a
subcontract, that it is seeking bids using advertising media such
as the Purchasing Bulletin, newspapers, trade journals or any other
media targeted at those in West Virginia who may want to submit a
bid and give those interested at least thirty days to submit a bid
or notice of interest.

NOTE: The purpose of this bill is to require the Public
Insurance Agency and its contractors, under certain circumstances,
to advertise that they are seeking bids prior to accepting bids on
contracts.

Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.